The mental wellbeing of women who have abortions has long been used as a topic in the debate of whether or not to legislate for abortion, and has, at times, been used as tactic for warning people against abortion. But what does the research actually say?
This was becoming the world’s longest blog post, as it is taken directly from my Undergrad thesis; ‘“It’s amazing what women will put themselves through”: An exploration of Irish women’s abortion experiences from the viewpoint of their reproductive health counsellors”’. I’m going to give as brief a synopsis as I can, and if you wish to go ahead and read the full thesis I’ll link to it at the bottom of the blog. However, the take-away message from this blog post is, quite simply, that the mass majority of psychological and medical research supports the view that having an abortion does not negatively impact on mental health. However, restricting access to abortion does have a negative impact on women’s mental health.
(Although I am actively pro-choice on the issue of abortion, that does not sway the research, and I would have failed my thesis should there have been personal bias, and not proper scientific research conducted)
Decades of psychological study show that in relation to their mental and emotional wellbeing, the vast majority of women are not negatively impacted by having an abortion. However, lack of access to safe and legal abortion does impact negatively on mental and emotional wellbeing.
Worldwide, women who wish to terminate unwanted pregnancies will seek abortion at any cost, even when it is illegal or involves risk to their own lives (Sedgh et al., 2012). Evidence from various countries, including some with highly restrictive abortion laws, suggests that the use of the drug misoprostol as an abortifacient has been spreading and there are a number of known websites which provide Irish women with this drug.
Studies from the World Health Organisation repeatedly show that restrictive abortion laws are not associated with lower abortion rates, and in fact the abortion rate is lower in regions in which women live under liberal abortion laws, but restrictive abortion laws do lead to greater numbers of unsafe abortion (Sedgh et al., 2012). This is likely true of the Irish context, with Irish authorities seizing 1’216 abortion tablets in 2009 alone. This suggests that the actual number of abortions Irish women are having is much higher than those indicated by the figures presented by the NHS.
The polarization of the public discussion of abortion has inhibited women from naming the complexity of their experiences, and women express themselves as being caught in a vicious cycle: they felt that they would not be free to voice their experiences of abortion until the public perception changed, and yet they felt that the public perception of abortion would not change until women’s voices were heard.
A meta-analysis of 225 studies showing the adverse sequelae (e.g., distress, dysphoria) that occur in a minority of women seem to be the continuation of symptoms that appeared before the abortion (Dagg, 1991).
More recent studies show that negative responses to abortion are mostly social. Kimport, Foster, and Weitz (2011) found that two social aspects of the abortion experience produced, exacerbated or mitigated respondents’ negative emotional experience. Negative outcomes were experienced when the woman did not feel that the abortion was primarily her decision (e.g., because her partner abdicated responsibility for the pregnancy, leaving her feeling as though she had no other choice) or did not feel that she had clear emotional support after the abortion. The study concluded that experiencing decisional autonomy or social support reduced respondents’ emotional distress (Kimport et al., 2011).
For my thesis, I conducted a qualitative study which involved interviewing family planning counsellors to see how their combined years of experience of counselling women with unplanned pregnancies informed the current research around abortion and mental health. The result showed that women who decided to have abortions generally felt relief, not regret. However, the lack of access to abortion and the act of having to travel overseas, usually in secret, to attain an abortion created a very negative emotional response. In addition, the illegality of abortion and stigma around it did not dissuade women from seeking abortion. It did, however, create added emotional, financial and personal difficulty for the women in this position.
The aim of my study was to highlight the experience of Irish women who have had abortions from the viewpoint of their counsellors. Themes were split between three areas – the counsellors, their clients, and the Irish social context. Counsellors report that the reasons women give for choosing abortion include lack of money or resources for raising a child, timing in life, lack of support and concern for other relationships. These findings are in accordance with those presented by Finer and colleagues (2005) and Torres & Forrest (1988). In relation to clients emotions, the research found that negative emotional outcomes were experienced when woman do not feel that the abortion was primarily her decision. This is in line with research by Kimport, Foster and Weitz (2011). The evidence presented by Clare and Tyndall (1994), that some women who have strong religious attitudes negative to abortion experience emotional struggles in relation to these beliefs, is also an issue for some Irish women, particularly catholic women, according to counsellors.
Counsellors hold that any negative feelings women present with are not usually around the actual abortion, but other issues in their life that may relate to their abortion, such as relationship problems, lack of support, and feelings of being ostracised. Counsellors hold that the client is lost in the political debate, and their needs and the reality of abortion in Ireland is not being addressed. Counsellors believe that secrecy, stigma and lack of support in Irish society all contribute to extra difficulties for Irish women. These findings are reflective of the research by Boyle and McEvoy (1998), who concluded that while their findings reflect the bulk of research regarding the psychological issues surrounding abortion, in that abortion in itself is not emotionally damaging, the difficulties faced in relation to abortion are intensified in the Northern Irish context where abortion is illegal.
This study also found that in due to the illegality of abortion and the stigma surrounding abortion in Ireland, counsellors believe that women may not disclose having had an abortion to their GPs and other healthcare providers, with anecdotal evidence of women travelling out of their county altogether just to obtain advice and information on abortion. Counsellors report that abortion secrecy is a very burdensome problem for Irish women, and fear of revealing a previous abortion to their medical provider is common. These findings are similar to the research by Logsdon and colleagues (2012), who found that a perception of judgment from the regular health care provider may also prevent women from disclosing a previous abortion, causing a disruption in continuity of care. Boyle and McEvoy (1998) also found this to be the case in their study of Northern Irish women, stating that the level of secrecy which Northern Irish women felt was demanded of them may have important implications for access to medical services after the abortion.
Regarding the difficulties surrounding travelling for abortion, counsellors report that travel costs are also a very big issue, along with other logistics facing women who must travel, such as finding childcare and time of work. This is reflective of the study by Becker and colleagues (2011). It would be reasonable to suggest that this is more difficult for women with less means, both financial and in relation to support. Counsellors report that some women are self administering the abortion pill, and that this is a particular problem for migrant women who do not have access to travel visas, with counsellors reporting knowledge of unsafe abortion practices among migrant women. According to Sedgh (2012), self-administering abortion pills is classified as unsafe abortion.
One of the aims of this research was to understand women’s experience of abortion in the Irish social context. Counsellors reported that the polarization of political and social discourse on abortion in Ireland has an adverse effect on women. Frustration and anger with the obstacles and barriers faced, along with the stigmatization felt by women who do have abortions, are common emotions that women present with in pre and post abortion counselling. Counsellors hold that while women are generally accepting of their decision to terminate a pregnancy and usually feel a sense of relief, issues surrounding guilt and shame are created via the social context and public debate. Counsellors also believe that propaganda is confusing women about their emotions, making them question whether they should in fact feel guilt and shame instead of moving forward with their lives. Counsellors report that a recent resurgence in media coverage, anti-abortion propaganda and political debate has brought women into counselling who had not previously sought post-abortion counselling. Counsellors believe that this propaganda and discourse is negatively impacting on women who have had abortions. Counsellors do not, however, believe that protesting and propaganda deter women from seeking abortion, but simply make it more difficult and upsettingThe obstacles faced by Irish women are also extremely frustrating for the counsellor, particularly when it comes to very much wanted pregnancies that are unviable due to fatal foetal abnormalities. Counsellors cite these frustrations as challenging. Counsellors believe the lack of choices and autonomy that women face in relation to their reproductive rights in Ireland goes against the counselling ethos of support for a human being.
While counselling is about helping women come to terms with having chosen to have an abortion, counsellors also believe that abortion would be less traumatic with acceptance reached sooner if women did not have the extra obstacle of having to travel to obtain abortion. Some counsellors believe that women would actually take more time with deciding the best course of action for them in relation to their options around a crisis pregnancy. Counsellors also believe that the extra barriers Irish women face in obtaining abortions perpetuates stigmatization which creates emotional difficulties for their clients. While the barriers do not deter women from obtaining abortion, they exacerbate the difficulty of the situation and make it a more distressing experience, according to counsellors.
Counsellors state that the physical implications of lack of availability of abortion in Ireland create a situation where terminations are happening in later stages of gestation because more logistical and financial factors need to be in place before the abortion can occur. Counsellors also report that many women are undergoing surgical abortion instead of medical abortion so that they can get back to Ireland more quickly, often because they cannot afford to stay away from home longer than one day.
A very problematic issue that arose in this study is the extra restrictions placed on migrant women in Ireland, and the ways in which they may attempt to terminate pregnancies. Counsellors report that asylum seekers with refugee status and migrant women with visas that do not allow EU travel have fewer options, delaying the abortion process and/or leading to situations where women are using pills, herbs and backstreet abortions deemed as unsafe (Sedgh et al, 2012).
This thesis was completed in 2013. The political debate around the X case along with the tragedies of Savita Halappanavar, Bimbo Onanuga and Migrant X, among many other women, has since allowed for much more discussion around abortion. But the laws pretty much remain the same, with women now facing 14 years in prison if they obtain an abortion in Ireland (unless their life is at immediate risk). There are multiple issues regarding abortion in Ireland, or lack thereof, but this blog is only related to the question of abortion and mental health.
If you are experiencing a crisis pregnancy, or are struggling with any of the issues that this blog discusses, please check out http://www.positiveoptions.ie. There is also a list of all types of helplines in Ireland on my homepage.
link to full thesis: https://bebhinnfarrellpsychotherapy.com/2015/10/26/full-thesis-on-abortion-and-mental-health/
link to Guttmacher study “Abortion and Mental Health: Myths and Realities”: http://www.guttmacher.org/pubs/gpr/09/3/gpr090308.html
If you wish to book a psychotherapy session with Bébhinn please click here: https://theirishwellnesshub.com/book-an-appointment/